vaginalis Bacterial vaginosis Females Cervicitis Vulvovaginitis Urethritis Bacterial vaginosis BV Salpingitis pelvic inflammatory disease PID Endometritis Genital ulcers ID: 1039052
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1. Candida infection Tricpmonas vaginalisBacterial vaginosis
2. Females CervicitisVulvovaginitisUrethritis Bacterial vaginosis (BV)Salpingitis (pelvic inflammatory disease [PID]) Endometritis Genital ulcers Pregnant females Disease in the neonate. Children and postmenopausal womenMales UrethritisEpididymitisProstatitisGenital ulcers Type of infection
3. Abnormal vaginal secretionNormal physiological vaginal secretionVaginal infectionTrichimoniasisVulvovaginitis candiasisBacterial vaginnosisDesquamative inflammatory vaginitisCervicitis InfectiousNoninfectiousEsterogen deficiency
4. History & symptoms of valvovaginitis General gyneclogical history( age Neonatal ,pregnancy,prepubescent,atrophic post menop) Onset,,Esterogen depletion)Menstrual historyPregnancySexual HxContraceptionSexual relationshipPrior infectionGeneral medical HxAllergiesDMMalignanciesImmunodeficiecyMedication OCP<steroids,duchesSymptomsDischarge(quality scanty)physiological OCPOder(BV,FB,EV fistula)Valvular disconfort(HSV)DyspareuniaAbdominal pain (tricho) PID
5. ExaminationBreastAdequate illuminationMagnification if possibleGive a patient mirrorInspect external genetaliaLesionsErythemaVaginal mucosaErythemaLesionSecretionExamination of cervixEctropionLesionsErythemaEndocervical secretionCollect cervical and vaginal specimenBimanual examination
6. Desquamated vaginal epithelial cellLactobacilli dominatePH 3.5 to 4.6OderlessNo itching or irritationDeonot soil underclothing1 Characteristic of normal vaginal secretion
7. The human vagina Lined with 25 layers of epithelium cells. Separation of microbial pathogens from the normal genital microbs. LactobacilliCorynebacterium spp.Gardnerella vaginaliscoagulase-negative staphylococci, Staphylococcus aureus Streptococcus agalactiae Enterococcus spp. Escherichia coliAnaerobesYeasts
8. Vaginal PH examination
9.
10. Candida infectionsyeast infection moniliasisCandidiasis or thrush is a fungal infection (mycosis) of any of the Candida species (yeasts) of which Candida albicans is the most common.Common superficial infections of skin and mucosal membranes by Candida causing local inflammation and discomfort.
11. Cassification of vulvovaginitisUncomplicatedSporadicNo underlying diseaseBy Candida albicanNot pregnanatMild to moderate severityAny available topical agentFluconazole 150mg as a single oral dose ComplicatedUnderlying illnessHIVDMRecurrent infection 4 or more per yearNon albican candidaPregnancySever infectionCulture confirmation mandatoryAntifungal suscep. TestingTreat for 10-14 days with vaginal or oral agentOther topicalBoric acid5 fluorocytocineConsider treatment of the partnersLong term suppressive treatment for frequently recurrent diseases
12. Candidal vulvovaginitis vaginal thrushInfection of the vagina’s mucous membranes by Candida albicans.75% of adult womenFound naturally in the vaginaHormonal changesChange in vaginal acidity. Broad-spectrum antibiotics.Use of corticosteroid medications Pregnancy.20-30 yearsPoorly controlled diabetes mellitus.
13. Risk factors AntibioticsPregnancyDiabetes (poorly controlled) ImmunodeficiencyContraceptivesSexual behaviourTight-fitting clothingFemale hygiene
14. SymptomsVulval itching Vulval soreness and irritationSuperficial dyspareunia.DysuriaOdourless vaginal dischargethin and watery or thick and white (cheese-like)Erythema (redness)Fissuring satellite lesions.
15. Types of candidal vulvovaginitisUncomplicated thrushsingle episode/less than four episodes in a year. mild or moderate symptomscaused by the Candida albicans .Complicated thrushfour or more episodes in a year.severe symptoms.Pregnancypoorly controlled diabetes/immune deficiency.not caused by the Candida albicans
16. Diagnosis History & symptomsphysical and pelvic examCandidiasis can be similar to other diseases:Sexually transmitted diseases Chlamydia Trichomoniasis Bcterial vaginosis Gonorrhea
17. Candida albicans
18. TreatmentButoconazole creamClotrimazole1% creamvaginal tabletMiconazole2% creamvagina suppositoryNystatinvaginal tabletOral Agent:Fluconazole- oral one tablet in single dose
19. Treatment Short-course topical formulations single dose and regimens of 1–3 dayseffectively treat uncomplicated candidal vulvovaginitisTopical azole drugs are more effective than nystatinAzole drugs relief of symptoms in 80%–90% of cases.Treatment failureIn up to 20% of casesIf the symptoms do not clear within 7–14 days
20. Trichomoniasis (sexually-transmitted infection) SymptomsPurulent vaginal dischargeyellow or greenish in colorVulvar irritation (strawberry)DysureaDyspareuniaAbnormal vaginal odor The wet mount's fast results
21. Culture is considered the gold standard for the diagnosis of trichomoniasis. Its disadvantages include cost and prolonged time before diagnosis
22. ManagementConfirm the diagnosisWet preparation (miss 30%)CultureGram StainConfirm all current sexual partners treatedOral metronidazole 500 mg bid for 7 days2 g daily for 3-5 daysIf Rx failure -Consultation with expertsSusceptibility testingHigher dose of metronidazoleAlternative Tinidazole
23. Lactobacillus acidophilusGardnerella vaginalisMycoplasma hominisMobiluncus speciesAnaerobesBacteroides (Porphyromonas)Peptostreptococcus FusobacteriumPrevotella Bacterial VaginosisLactobacilli Compete with other microorganisms for adherence to epithelial cells Produce antimicrobial compounds such as organic acids (which lower the vaginal pH) hydrogen peroxide, and bacteriocin-like substances Floral imbalance
24.
25. Marked reduction in lactobacillus Decreased hydrogen peroxide productionPolymicrobial superficial infection: overgrowth of G. vaginalis and anaerobic bacteria Lactobacilli predominate after metronidazole treatment Pathogenesis
26. The most common vaginal infection in women of childbearing age-29% Risk factors Multiple or new sexual partners (sexual activity alteration of vaginal pH)Early age of first sexual intercourseDouching Cigarette smoking Use of IUD *Although sexual activity is a risk factor for the infection, bacterial vaginosis can occur in women who have never had vaginal intercourse Epidemiology
27. Most cases (50-75%) Homogenous grey vaginal dischargeDysuria and dyspareunia rare Pruritus and inflammation are absent Fishy vaginal dischargeDuring menstruationAfter intercourseMinimal itching or irritationAbsence of inflammation is the basis of the term "vaginosis" rather than vaginitis Clinical Features
28. OB complicationPreterm deliveryPremature rupture of membranesAmniotic fluid infectionChrorioamnionitisPostpartum endometritisPremature laborLow birth weightGYN ComplicationPelvic inflammatory diseasePostabortal pelvic inflammatory diseasePosthysterectomy infectionsMucopurulent cervicitisEndometritisIncreased risk of HIV/STDBV complications
29. Simple, inexpensive, office-based tests were underutilized. Microscopy pH measurementWhiff amine testOFFICE-BASED TESTS FORVAGINITIS ARE UNDERUTLIZED
30. Clinical diagnosis.3 out of 4 of these criteria._____________________________________PH greater than 4.5Positive Whiff test Any clue cells Homogenous discharge.CLINICAL DIAGNOSIS OFBV
31. Gram Stain Diagnosis (cont.)
32. Normal vaginal gram stain
33. BV
34. Sample of vaginal secretions are placed in a test tube with 10% KOH.KOH alkalizes amines produced by anaerobic bacteria-results in a sharp "fishy odor"KOH "WHIFF" TEST
35. Diagnostic MethodsClinical/Microscopic Criteria Gram Stain (“Gold Standard”)Clue cells on saline wet mount of vaginal discharge (on >20% cells)Bacteria adhered to epithelial cells; most reliable single indicatorVaginal pH > 4.5 Elevated pH and increased amineSensitivity 87%; Specificity 92% *Culture- poor predictive value for G. vaginalis as prevalent in healthy asymptomatic women *DNA probes- expensive, poor predictive value alone
36. Diagnosis by Gram Stain
37. Treatment RecommendationsOral metronidazole 500 mg bid x 7 days ($5)84-96% cure rateSingle dose therapy (2g) may be less effectiveOral Clindamycin 300 mg bid x 7 days ($28)Less effective Topical treatments (higher recurrence rates)Metronidazole gel (0.75%) 5 g PV qhs x 5 days ($30)70-80% cure rateClindamycin cream (2%) 5 g PV qhs x 7 days ($31)Less effective May lead to Clindamycin resistant anaerobic bacteria
38. Specimen Obtained during gynecological examinationVaginal secretionPHSaline wet preparationKOH wet preparationCervical cultural and non culturalGCC.trachomatisVaginal cultureCandidaTrichomonas vaginalisCervical cytological examination if not documented within previous 12 months
39. Routine bacterial cultures not helpfulRoutine NOT helpfulWet mount- 60% sensitive (Trichomoniasis ,BV )Abnormal or foul odor using a (KOH) "whiff test,"The Gram stain is useful to diagnose BVUsing the Nugent scoring system A wet mount+ a yeast culture and Trichomonas cultureRecommended tests to diagnose vaginitis. Performing only a wet mount, without yeast or Trichomonas culture, 50% of either of these agents of vaginitis will be missedA sensitive DNA probe assay is available Combines the detection of yeasts, Trichomonas, and G. vaginalis as a marker for BV